Introduction: Atypical fibroxanthoma is a low grade soft tissue
sarcoma infiltrating the dermis containing pleomorphic spindle cells.
Pleomorphic dermal sarcoma is a rare dermal tumour on the same
morphological spectrum as atypical fibroxanthoma, with greater potential
for malignancy. Distinguishing between the two tumours can have a
significant impact on management. Case: An 81-year-old gentleman
presents with a black haemorrhagic lesion demonstrating features of
atypical fibroxanthoma. The diagnostic pathway of this case is followed,
focusing on wide local excision and histopathological examination of the
offensive tissue, and highlighting decisions made during these stages.
Discussion: Common clinical features of atypical fibroxanthoma is
detailed, and potential for larger trials to focus on clinical features
in symptomatic individuals. The difficulty orientating auricular tissue
and methods to reduce potential loss of tissue is discussed. Finally,
this report delves into guidelines for wide local excision and what is
appropriate for atypical fibroxanthoma or pleomorphic dermal sarcomas.
Conclusion: Management of atypical fibroxanthoma can vary from
pleomorphic dermal sarcoma or more aggressive sarcomas. This report
emphasises the need for a streamlined diagnostic pathway to improve
treatment benefit for patients and reduce waiting times.